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Oct 9, 2017

Save the Children CICF End line Evaluation Consultancy in Kenya

Save the Children

Terms of Reference for Endline Survey

Programme Title: Increasing access to quality care for preterm and low birth weight babies in Kenya through Kangaroo Mother Care, and Improving the monitoring of labour using a mobile based partograph.
Subject of service / contract: End line Evaluation
Duration of evaluation: 23rd Oct - 10th Nov 2017
Save the Children Contact: Head of Monitoring and Evaluation, Accountability and Learning

Project Background and Context: Maternal and neonatal health indicators in Bungoma county have improved during the demographic and health inter survey period (2008-2014) although much more efforts are needed to improve indicators such as skilled birth attendance (41.4% for Bungoma compared to 62% national) and four ANC visits (51.3% for Bungoma compared to the national average at 57.6%) {Kenya Demographic and Health Survey 2014}

These are all indicators that determine maternal and neonatal outcomes. . Maternal mortality represents the biggest health disparities between the rich and poor countries, and rich and poor communities within the countries. 

The risk of a woman dying from pregnancy complications in Kenya is higher at 1 in 38 compared to a much lower risk of 1 in 3500 in developed countries and intra partum related complications are among the leading causes of death for mothers and new-borns in Kenya (WHO 2014).
The KDHS 2014 estimate for Kenya’s Maternal Mortality Ratio (MMR) stands at 362 deaths per 100,000 live births, a decrease from the KDHS 2008 estimate of 488 deaths per 100,000 live births although it’s difficult to conclude whether or not there has been any change over time between the two surveys because the differential is not large enough. 

There have also been improvements in neonatal mortality rates from 31 deaths per 1,000 live births in 2008, to 22 deaths per 1,000 live births in 2014. 

The leading causes of neonatal mortality are inter alia complications around prematurity, birth asphyxia and sepsis; with prematurity now being the leading cause.
Save the Children with funding from County Innovation Challenge Fund (CICF) is implementing a project with an aim of improving the monitoring of labour through the use of a digital version of the WHO partograph. 

This has been installed on an android platform and curently in use for selected facilities in Bungoma to address the gap resulting from under-utilization of the paper based partograph.

The key functions within the application include real time information entry ad utilization, providers alert system andtreatment options to help service providesr to promptly detect and decide on the appropriate care for the client. 

This is envisioned to contribute to early recognition and thus appropriate treatment and care for women with potential complications in a timely manner. 

This will also address the challenges faced in use of the paper based partograph. A partograph is an effective tool, advocated by the World Health Organization, for monitoring and management of labour and when properly used, it is effective in early detection and management of complications during labour and delivery (Lavender et al 2008)..
The project also seeks to improve access to care for preterm and low birth weight babies by scaling up the use of Kangaroo Mother Care (KMC) in selected sub-counties; Tongaren -Tongaren Health Centre, Naitiri sub county hospital, Ndalu health centre, Webuye West - Webuye county hospital, Milo health centre, Lugulu mission hospital, Bokoli Sub county hospital, Kanduyi – Mechimeru model health centre, St. Damiano, Kabuchai – Kabuchai health centre, Nalondo model health centre, Chwele sub county health hospital, Kimalewa health centre, Sirisia – Sirisia sub county hospital, Luandanyi dispensary, malakisi health centre, Kimilili – Maeni dispensary, and Mt.Elgon – Kamuneru dispensary within Bungoma County. 

This intervention is building on Save the Children’s experience in establishing KMC in Bungoma County as well as learning from the organization’s global expertise in KMC. 

The project has worked with BBC Media Action to increase awareness on KMC to address community level misconceptions on care of small babies. 

The implementation sites were selected based on the number of preterm and low birth weight babies that were being referred to the County referral hospital from these areas.

These two above interventions were aimed at improving access to quality service delivery by pregnant women and new born hence contributing to a reduction in maternal and new born mortality and morbidity.
To assess the processes of the interventions and collect evidence of their effectiveness in improving quality of care and reducing maternal and neonatal morbidity and mortality. 

This evaluation will provide information that will enable Save the Children and its partners to measure the outcomes and progress towards achievements of the goal as well as provide information for future programming including lessons learnt.
The End line evaluation will explore the following key evaluation questions and develop recommendations based on the findings:
1. Assess the project objectives and proposed outcomes by measuring performance against project outcome indicators under each result area.
2. Measure the changes in coverage and quality of basic KMC and paper partograph vs e-partograph.
3. Examine the critical factors that affected the attainment of the project results.
4. Evaluate efficiency of the organizational set‐up and systems used in the delivery of the project and to what extent these contributed to or inhibited the delivery of the project outcomes.
5. Document lessons learned during project implementation and make recommendations for scale up and replication.
6. Assess sustainability of the interventions by assessing the capacity of the county health systems and document any gaps and areas of strengthening required.
The consultant will propose appropriate mix of qualitative and quantitative methodologies; and tools as well as an appropriate sample size; the methodology should also clearly state how bias will be avoided. 

The consultant will apply appropriate data collection tools (e.g. questionnaire, checklist, exit interviews etc.) for interviews and discussions with proposed project beneficiaries, stakeholders including county department of health, other implementing partners and Save the Children staff.
Reference material
i. Project proposal
ii. Baseline survey report
iii. Project activities report
iv. Updated project log frame
v. Child Safeguarding policy
Evaluation questions to be answered, these should be very specific questions and focus on:
Criteria and Questions
  • To what extent did the CICF project address access to quality care for preterm and low birth weight babies in Bungoma through Kangaroo Mother Care
  • Was there any improvement in the monitoring of labour using a mobile based partograph compared to paper based?
  • Indicate for each expected outcome and output (result) what has been accomplished in relation to what has been stated in the project document, logical framework.
  • What strategies have proven particularly effective for achieving the outcomes?
  • What were the challenges to effective implementation, with the aim of learning from Program?
  • Were objectives achieved on time and within budget in the supported program?
  • Were the proposed activities cost-efficient?
  • Identify and analyse the significant changes that the project has brought in mothers and new-born’s lives and what has led to that change.
  • What real difference has the intervention made in the lives of the beneficiaries?
  • Assess the progress towards the actual project impact.
  • Document any evidence of practical success (case stories) and successful approaches.
  • Assess the sustainability of the results (will the outcomes endure; how likely does continuing progress towards the impact seem, and what are the major factors contributing or hindering sustainability – e.g. capacity building of partners, etc.).
  • Assess to what extent and how the project has increased the commitments, accountability and capacity of duty bearers. Document ownership and involvement of Government and communities at different levels, and other key stake holders e.g. Facility Management Committee / Community Health Committee, Community Health Management Team, Sub County Health Management Team
The end line evaluation will cover all nine sub counties in Bungoma county (Kanduyi, Kimilili, Mt Elgon, Cheptais, Bumula, Kabuchai, Webuye West, Sirisia and Tongaren) for Kangaroo Mother Care scale up and four sub Counties (Bumula, Cheptais, Mount Elgon and Kimilili) for e-partograph pilot intervention.
In particular the consultant will;
a. Verbal briefing with Save the Children Country office technical staff to discuss background and key issues for the evaluation.

b. Conduct a background desk review of all relevant projects as outlined in the section on reference
c. Develop a detailed evaluation inception report that should present the approach, methodology, detailed planning and logistics support requirements and data collection tools to be used.
d. Hold meetings with the field office technical and implementation staff as well as stakeholders.
e. Train enumerators (this will be a mix of both male and female)
f. Conduct data analysis of all data collected for purposes of the evaluation and finalize the report.
g. Submit all data sets including transcribed qualitative data.
h. Conduct a validation workshop
The end-line evaluation process is estimated to take in total 14 days with a tentative start date of 23rd October 2017. 

The draft report will be submitted and presented to Save the Children (SC) and partners before 6th November 2017 and the final report must be submitted before 10th November 2017.
End line survey report including findings and recommendations for project design as well as the raw data sets.
Data sets: Quantitative data should be analysed using SPSS, STATA or Excel and qualitative data should be transcribed for future use by Save the Children Country Programmes. 

This should also be submitted within 10 working days after completion of field work

The Evaluation team would entail the Technical Specialist, Head of MEAL, Project Managers, and MEAL Coordinators, Consultant lead.

Title and Responsibilities
Technical Specialists
  • Provide feedback on the inception report
  • Consolidate all feedback from project team and PDQ and share with the Consultant
  • Share technical feedback on the first draft shared by the consultant.
  • Support the consultant in disseminating findings to Save the Children Staff and external stakeholders.
Head of MEAL
  • Review the Methodology of the study.
  • Review inception report submitted by the consultant – majorly on the sample size, sample distribution.
  • Review the study tools to analyse the quality checks and propose changes.
  • Ensure quality in all the steps i.e. design, sampling, data collection.
  • Coordinate evaluation process ensuring that the evaluation checklist is adhered to.
  • Review and sign off the final evaluation report.
MEAL Coordinator 
  • Supervising the field data collection.
  • Share post enumeration plan with consultants.
  • Run data quality checks during data processing for internal evaluation.
  • Ensure quality in all the steps i.e. design, sampling, data collection.
  • Review inception report and data collection tools
Project Manager / Area Program Managers
  • Review tools and make sure that all tools are aligned to TORs and cover all indicators and variables required for decision making.
  • Provide necessary logistics and do the necessary introductions to the researchers.
  • Provide project documents – proposals, log frame, MEAL plans, and progress reports.
  • Review first draft shared by consultant and provides strong technical and contextual input so that final report comes up with required quality.
Lead Consultant
  • Review the project documents
  • Submit the inception report.
  • Development and review of data collection tools.
  • Ensure data collection, entry and analysis.
  • Debrief at the field on preliminary findings and at the CO on findings
  • Submission of draft evaluation report for review – as per SCI format.
  • Validation workshop with community and other stakeholders including children.
  • Submission and approval of final evaluation report and datasets.
  • Training of enumerators and project team (internal)
  • Dissemination of findings to experts and national stakeholders where necessary.
  • Seek Ethical approval and obtain an Ethical approval certificate
a. An inception report: The consultant will share his/her inception report that details the study design (rationale, methodology), data collection tools, and a detailed work plan within 1-5 days of engagement; this will be approved by the Head of MEAL & Health Specialist.
b. Draft Evaluation report: The consultant will prepare a draft evaluation report with details of findings, recommendations and lessons learnt for review by Save the Children and partners. Evaluation report template will be shared with consultant.
c. Final Evaluation report: The consultant will share a final evaluation report after incorporating the comments from Save the Children and consortium partners. The evaluation report is an exclusive property of the Save the Children and should not be released without prior authorization. This will be both in electronic and hard copy. The report shall be presented as MS Word document of no more than 40pages excluding annexes and PowerPoint not more than 12 slides).
d. All data sets: Consultant will deliver the data sets to Save the Children (SPSS, Stata / excel for quantitative and for qualitative the transcribed data).
e. Two pages brief that include the evaluation key findings, recommendations and lessons learnt.
Save the Children will facilitate the lead consultant and his two to three members of his team with accommodation costs in the field, transport to Bungoma and back. 

The consultant should share the budget prepared in the format that would be provided as an annex. The budget should be accompanied by a work plan for the duration of the contract.
The following payments will be made to the consultant using an agreed mode of payment:
  • 20% of the budget will be paid upon submission and approval of inception report.
  • 20% will be paid upon submission of draft report.
  • 60% of the end line budget will be paid upon submission of the final report and the other agreed deliverables and approval by head of MEAL and health specialist.
Note that no payments will be made without written formal approval of the deliverables (inception report, draft report and final report)
5% withholding tax will be retained as part of the payment and remitted directly to the Kenya Revenue Authority and the consultant should ensure that their budget includes this figure.
a. Advanced university degree in public health / health systems management or related health field.
b. At least 10 years’ experience in the area of maternal, new-born and child health and public health.
c. Sound knowledge and experience working in the counties of Kenya, and familiarity with their health systems.
d. Be well informed in gender and rights based programming in the development sector.
e. Demonstrated knowledge of project evaluations and possess strong research skills.
f. Experience in the formulation, monitoring and evaluation of RMNCH projects.
g. A demonstrated high level of professionalism and an ability to work independently and in high-pressure situations under tight deadlines.
h. Strong interpersonal and communication skills
i. High proficiency in written and spoken English
j. Ability to use mobile data collection systems and analysis software like Stata and SPSS.
k. Understanding of child safeguarding and child participation procedures
As the consultant will be working on behalf of Save the Children he/she will be required to sign and adhere to the Child Safeguarding Policy and ethical guidelines. Note that background checks will be undertaken on all applicants.
The title rights, copyrights and all other rights of whatever nature in any materials used or generated under the provisions of this consultancy will exclusively be vested with Save the Children Kenya Country office. 

All products developed under this consultancy belong to the project exclusively, guided by the rules of the grant contract.
Under no circumstances will the consultant use the information of this evaluation for publication or dissemination without official prior permission (in writing) from Save the Children Kenya.
All interested Individuals / firms are requested to express interest following our Expression of Interest form ONLY (CLICK HERE to download) by email to: [email protected] indicating the assignment title in the subject line. 

The applications close on 14th October, 2017

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